Is family planning the best way to prevent teenage pregnancy?

There has been a controversial public debate on whether or not to allow pupils as young as 10 years access family planning services as one of the means to reduce early pregnancies among adolescents.The argument followed a Daily Monitor article published on February 9, that the fourth edition of the 2016 Health Ministry policy statement requires all health facilities to provide quality services to all adolescents irrespective of age, sex, ability to pay and marital status.The teachers were the first stakeholders to oppose the move, if approved, warning government not to be misguided by donors to give in children arguing that donors are trying to take advantage of them.

“We need to ensure our own children get the right information, material, content and guidance from the right people,” James Tweheyo, Uganda National Teachers Union (Unatu) general secretary, argues.But a different view is shared by for sex reproductive health advocates saying that restricting teenagers from accessing contraceptives does not kill their curiosity and will end up getting pregnant.Doreen Kansiime, the project and advocacy officer at Reproductive Health Uganda (RHU), says rather than discouraging adolescents, they have promoted sex education talk in schools where pupils are cautioned about the risks of the family planning methods.“So by the time they come to our facilities, they know. We also have service providers who discuss with adolescents the most appropriate contraceptives such as condoms although we don’t provide long term family planning methods to young people,” Kansiime states.As such, she says all young people in birth giving age groups should be given access to contraceptives.

What doctors sayKansiime’s point of view is shared by Dr Peter Ssebadduka, a gynaecologist at Mulago Hospital, who says that there is no health hazard in having teenagers as early as 13 years using contraceptives as opposed to adults.“There is no medically proven research that proves any effects caused by contraceptives among teenagers. Actually, contraceptives are safer among the teenagers than the adults,” Dr Ssebadduka declares .

Teenagers, Dr Ssebadduka further states, are restricted from contraceptive use only for socio-cultural reasons otherwise, they have proven to be safer among the young people.He adds that: “[Hormonal] Contraceptives like pills and injecta-plan should actually be encouraged more among young people than those in older age groups.”Dr Richard Karungi, a general medical practitioner at Royal Health care Hospital in Kawempe approves Dr Ssebadduka’s assertion.Dr Karungi adds that contraceptives are not about age groups as the same challenges that an older woman faces when they use contraceptives without consultation is the same as that a young person would face when they do the same.

“I think the discussion should not be about when to use them but how to use them. The fear is mainly social. It is more of pretense but the young people are having sex anywhere,” Dr Kaungi says.Dr Karungi adds that a good number of young people are already on contraceptives because they are also prescribed as medication to streamline their menstrual cycles.“If young people at as early as the age of 13 are carrying out abortion, then why can’t they access contraceptives to protect them from early pregnancy,” Dr Karungi says.Specifically, he recommends that contraceptive pills would be the most appropriate type of hormonal birth control tool for young people since they do not alter their menstrual cycles compared to other hormonal contraceptives.On the other hand, the suppliers also find themselves in a dilemma on the likely effects of denying adolescents who come to procure them.

A drug dispenser’s dilemmaA pharmacy attendant, who did not want to have his name revealed because of the controversy around the issue says it is always hard for him to choose between saving the life of a teenager who would rather opt for a deadly abortion if denied contraceptives.He says, “If someone has been involved in sexual intercourse and needs emergency pills, you can’t ask for their age first but instead you concentrate on saving their life the next thing you will hear is that they died in the process of carrying out an abortion.”

Another pharmacy attendant in the Soroti District rural pharmacy says that when young people come to the pharmacy to ask for contraceptives, she only teaches them how to use the drugs very well and also tells them the effects.“I do that out of choice because there are no guidelines restricting a particular age group from accessing contraceptives,” she says.The National Drug Authority (NDA) which is mandated to regulate drugs and food in the country says that their role is to ensure that the drugs supplied are of good quality and effective as well as displayed by a qualified professional.“They [pharmacists] are knowledgeable enough in terms of diagnosing in respect to the particular age groups that is why we always ask the public to only use the drugs strictly on prescription of a professional physician,” Fredrick Sekyana the NDA spokesperson says.“If you do not follow the right procedure, it is up to you,” he adds.

Mixed reactionsNevertheless, some parents still insist that accepting their sons and daughters to freely access birth control measures would expose them more to sex and other sexually transmitted diseases and the girls reduced to sex objcets.Mariam Batanda a housewife and mother of two is shocked to hear anyone could think of introducing young people regarding it as unbelievable and unheard of.“Believe me i don’t want to hear bout that. It is the most embarrassing and annoying statement I have heard. I am so disgusted,” Batanda says adding that those who are already sexually active should be lectured about contraceptives but the young ones be spared.

But whereas Batanda, is irked by the whole idea, Andy Mwesigwa, a marketer and father of two says he would not have any problem with supplying teenagers with contraceptives. He argues that the same doctors who discourage teenagers from accessing contraceptives also help young girls to carry out unsafe abortion.“After all, doctors are getting richer for illegally selling abortion pills and contraceptives behind the counter. And charging exorbitant prices,” Mwesigwa says.Early marriage, early initiation of sex and lack of information, are said to be the leading drivers of adolescent pregnancy.Information from World Health Organisation also shows that maternal deaths are higher in teenage mothers than older women. According to WHO, it is important that family planning is widely available and easily accessible through midwives and other trained health workers to anyone who is sexually active, including adolescents.

Under reviewHowever, the Ministry of Health has since disputed the story saying that it was based on the National Policy Guidelines and Service Standards for Sexual and Reproductive Health and Rights of 2012, which were not approved and have never been implemented.Dr Anthony Mbonye says that the guidelines are currently being reviewed and updated by the Minister of Health and development partners to address changes in facts, statistics and practices, before a revised document can be endorsed for implementation.“The guidelines under review can only be endorsed after all the queries have been adequately and efficiently addressed and loose ends tightened,” Dr Mbonye clarifies in a press release issued last week.

Issue at hand

According to Uganda Demographic Health Survey 2011, about 14 per cent of young women and 16 per cent of young men had their first sexual encounter before of 15 while 57 per cent of young women had their first encounter before 18.The Population Secretariat indicates that of the 1.2 million pregnancies recorded in Uganda annually, 25 per cent are teenage pregnancies.These more than 300,000 teenagers also account for the bulk of unwanted pregnancies, unintended births or abortion.Although Uganda has several policies designed to protect young females but these policies have not been implemented. They include National Health Policy, National Adolescents Health Policy, sexual reproductive health minimum package, minimum age of sexual consent policy, and the defilement law, among others.

WHO guidelines also recommend that midwives are trained to provide (where authorised) locally available and culturally acceptable contraceptive methods while other trained health workers, for example community health workers, also provide counselling and some family planning methods. For methods such as sterilisation, the guidelines require women and men are referred to a clinician.

In Summary

A controversy ensued after a policy statement from the Ministry of Health revealed that health facilities would be required to provide reproductive health services to all adolescents irrespective of age, even though they are as young as 10 years old. Here is a look at various perpectives of the debate.